By Jonathan Shorman, July 30, 2016
Gripped by pain, Wanda Carlson headed to the emergency room Thursday night.
The 68-year-old Topeka woman has undergone multiple hip surgeries. Amid her ongoing medical issues, she’s been unable to be approved for Medicaid.
Without that coverage, her treatment is limited, she said. ER staff took X-rays, provided pain medication and sent her home. She can’t receive the kind of long-term care that Medicaid pays for.
Carlson applied in February, she said, and was denied a few days ago. Through the process, she said her daughter has attempted to navigate a frustrating call center and comply with requests to produce the same documents over and over.
As Kansas works through a backlog of unprocessed Medicaid applications and tries to improve its KanCare call center, an increasing number of patients, providers and advocates have shared stories of frustration. Their anger may come to a head this coming week when lawmakers gather to discuss issues with the program.
The KanCare Oversight Committee will meet Thursday and Friday. The panel’s work will include touring the KanCare Clearinghouse — the facility where workers field calls and wade through a mass of applications.
The frustration over the state’s struggle to eliminate a backlog of thousands of unprocessed Medicaid applications and a call center that leaves some unsatisfied has transcended partisanship — a rarity in the Statehouse. Both Republicans and Democrats are calling for improvements to the state’s privatized Medicaid program.
The state says the system is getting better.
“We continue to strengthen the eligibility determination process, and we are now processing considerably more applications than we receive each reporting period," Angela de Rocha, spokeswoman for the Kansas Department for Aging and Disability Services, said.
Carlson has never been on Medicaid before. The process leaves her disillusioned.
Although she is already enrolled in Medicare, that program doesn't typically pay for long-term care. Carlson, with the help of her daughter, applied for Medicaid in February. Two months passed.
Then, she received a letter asking for three months of bank statements, which she sent. She waited.
Again, a letter came asking for bank statements. Her daughter sent them again. Finally, a few days ago Carlson said she received an answer. She was denied.
The reason, she said: a funeral plan. The plan represents an asset she can borrow from. But Carlson said she’s not allowed to borrow against the plan. She plans to appeal.
In the meantime, she said she owes $40,000 from a stay at Plaza West Care Center, a cost she incurred believing she would qualify for Medicaid, which would significantly cut the amount she pays out of pocket.
Her family’s efforts to resolve the situation, including calls to the Clearinghouse, have yielded few results.
“It’s terribly frustrating, and you can’t talk to anybody,” Carlson said. “My daughter said she finally did talk to somebody last week who was nice and knew what they were talking about. She said the people she’s had to deal with before have been very abrupt and very rude and didn’t know they were talking about. They didn’t know what answers to give my daughter to very simple, basic questions.”
While each person’s experience with KanCare has its own twists, the state’s data and mounting anecdotal evidence point to real difficulties. The number of applications that have taken more than 45 days to process stood at more than 6,100, according to recent figures – though that’s down from more than 7,700 earlier in the summer.
KanCare serves more than 400,000 people in total.
Patients and providers have shared their own tales of problems. At a meeting in Salina this past week, they spoke with federal officials about issues they’ve encountered.
The state said of such meetings: “The majority of those who turn out are disgruntled for one reason or another.” Kansas has rejected the idea that KanCare is in crisis, and Gov. Sam Brownback has offered praise for the program.
“KanCare has overall worked very well,” Brownback said in late June. “Not that it hasn’t had difficulties, but overall I’ve been very pleased with the program, but this is something we thought we were getting the number down much faster — we’re getting the number down, but it’s not as fast as it needs to go.”
But Medicaid denials, like Carlson’s, have become a growing problem under KanCare, providers say. Jeremy Armstrong, CEO of Mitchell County Hospital in Beloit, said the facility has seen a 50 percent increase in denials since the implementation of KanCare.
Armstrong said the hospital estimates that about 90 percent of the denials are unjust and can be overturned.
“It’s not that we’re billing for services that shouldn’t be provided and paid for, we are. We’re having to jump through an awful lot more hoops to be paid for the services we are rightfully entitled to,” Armstrong said.
Complaints among hospitals over increased denials under KanCare predate the emergence of the backlog. In September 2013, The Wichita Eagle reported that less than a year into KanCare, Wichita hospitals were seeing a soaring number of denials. Lawrence Memorial Hospital voiced concerns with denials in December 2015.
De Rocha pointed to a 2010 report from the Kansas Health Policy Authority Inspector General that found a 27 percent denial rate in fiscal year 2007 and a 30 percent denial rate in fiscal year 2008, compared with a lower rate currently.
“The claims denial rates under KanCare are lower than they were under old Medicaid. The last report I have showed a 15.8 percent denial rate, including duplicates, for KanCare,” de Rocha said.
The backlog and a 4 percent reimbursement cut to providers that went into effect July 1 compound the challenges posed by denials, Armstrong argued. The hospital is set to lose about $65,000 a year under the rate cut.
“It just becomes even more and more challenging and frustrating as we try to provide the services that our community needs, many of them Medicaid and KanCare patients and residents,” Armstrong said.
Amy Turgon, an accountant at Sharon Lane Health Services in Shawnee, said individuals who should be rightfully enrolled in Medicaid are being denied by the state. Instead of making simple phone calls to confirm or obtain information on an applicant, the state sends out denial letters, she said.
Sharon Lane has filed more denial appeals this year than during the past six years combined, Turgon said.
And those denials often come after applicants have already waited months for a decision. Turgon said she believes the situation has only gotten worse, not better. She said at one point Sharon Lane sent emails to 12 different elected officials, including members of Congress, seeking help with 17 individuals’ cases.
“After doing that, all 17 of our issues were corrected within a week and a half. It should not take an act of Congress to get these issues resolved,” Turgon said.
Lawmakers on the KanCare Oversight Committee are openly frustrated and say they are coming to this week’s meeting — the first since April — seeking answers.
“We need to find out what their plan is, and if they don’t have a plan, they better get a plan,” said Rep. Dan Hawkins, a Wichita Republican who chairs the committee.
“Do you have a plan? If you do, is the plan working? Because it certainly doesn’t appear to be working very fast,” he said.
The backlog developed months ago after the state launched a new electronic eligibility system for Medicaid and opened a Clearinghouse facility to process applications.
Sen. Laura Kelly, D-Topeka, said she wants to know details about efforts to shrink the backlog and how the state will ensure it never happens again. She also wants information on how the state is working to prevent people from being lost in the process, such as state mental health hospital patients who are discharged and then need to receive Medicaid.
“I want to know what safeguards they’ve put in place to ensure those people don’t fall in those cracks between admission and post-discharge,” Kelly said.
De Rocha indicated changes are being made to make sure that once the backlog is eliminated, it does not recur during Medicaid open enrollment. The state has said it has retained temporary staff to process more applications.
“We believe that, going forward, the path to eligibility will be both shorter and smoother. The agency has worked both internally and with our vendor partners to ensure we can address the additional application workload during the period around open enrollment,” de Rocha said in a statement.
Hawkins indicated a desire to take on the 4 percent Medicaid reimbursement rate cut, which Brownback made earlier this year after lawmakers sent him budget legislation that didn’t balance. The cut is set to save the state about $38 million a year.
“That just exacerbates the problem. We already have a problem, now we have something piled on top of it that makes it worse,” he said.
Hawkins confirmed his desire to roll back the reimbursement rate cut in the opening days of the 2017 legislative session, which will begin in January. Rep. Steven Johnson, R-Assaria, has also spoken about efforts to combat the cut when the Legislature returns.
Both lawmakers said fees on insurance premiums would likely be increased to help raise the needed money. De Rocha has said the state doesn’t believe the reimbursement cut will harm patient access to care.
As lawmakers consider KanCare’s situation, Wanda Carlson will keep seeking approval for her Medicaid application.
As she speaks to a reporter, she admits to growing more frustrated the longer she talks about the topic. Getting onto Medicaid will reduce a lot of the stress she’s feeling, she said, as she wonders how she’s going to pay for services she’s used.
Her advice to others applying is simple.
“Prepare to be frustrated,” Carlson said. “Gather as much information as you can before you go into the process, and then prepare to be frustrated.”